State study of pyrotechnics-related injuries and property damage

In December 1993, the State of North Carolina legalized the sale of certain types of fireworks. To date, no study has examined the impact of legalization of fireworks on health care and public safety. The purpose of this study was to examine the impact of legalized pyrotechnics specific to our state with regard to injury, property damage, and suppression costs. The population groups surveyed were the state fire departments, county fire marshals, hospital emergency departments, and county forest rangers. Each group was asked to complete a questionnaire on all incidents involving pyrotechnics devices, both legal and illegal, used during the study period. A total of 233 responses were received from the 1644 agencies surveyed. Forty-one injuries and 129 fireworks-related fires were reported. Total property loss was $185,570. Property loss, injury costs, and fire suppression costs totaled $799,450. This study provides a very conservative estimate of the problem within our state. Stronger legislation to restrict access to pyrotechnics may reduce the damage and costs they cause.

Zinc gluconate and the common cold. Review of randomized controlled trials

OBJECTIVE

To examine the evidence of seven randomized controlled trials (RCT) on the therapeutic effectiveness of zinc gluconate lozenges for treating the common cold.

DATA SOURCES

Using the MeSH headings common cold and zinc gluconate, MEDLINE was searched from 1966 on for all published RCTs evaluating use of zinc gluconate for treating the common cold.

STUDY SELECTION

For this study, only double-blind RCTs were included.

SYNTHESIS

Fair evidence suggests that zinc gluconate lozenges have a therapeutic effect in treating the common cold. Starting therapy with zinc gluconate lozenges within 24 to 48 hours of onset of cold symptoms reduces the duration and severity of the cold. Patients must suck lozenges every 2 hours while awake during the cold. Minimum effective dose appears to be 13.3 mg of elemental zinc per lozenge. Evidence suggests that compounds such as citric acid, sorbitol, and mannitol bind the free zinc ion in the mouth, and this could account for variations in therapeutic benefit. Bad taste and nausea are important side effects of zinc lozenges.

CONCLUSION

Evidence supports use of zinc gluconate lozenges for reducing the symptoms and duration of the common cold, but the side effects, bad taste, and therapeutic protocol might limit patient compliance.

Clinical and serological responses to an inactivated influenza vaccine in adults with HIV infection, diabetes, obstructive airways disease, elderly adults and healthy volunteers

To investigate the clinical and serological responses to an inactivated influenza vaccine (split-virion A/Singapore/6/86-like strains H1N1 (15 ug HA), A/Beijing/353/89-like H3N2 (15 ug HA) and B/Yamagata/16/88-like strain (15 ug HA): MFV-JECT, Merieux, UK) in persons with HIV infection, diabetes, obstructive lung diseases, elderly adults and healthy volunteers. Forty-nine HIV-infected persons received 2 doses of the vaccine at one-month intervals; 34 healthy volunteers, 30 elderly persons, 29 with insulin and non-insulin diabetes and 14 with obstructive airways diseases were vaccinated with one single dose between October 1992 to January 1993. Serological testing of antibody responses was done using haemagglutination assay. Beta2-microglobulin in HIV-infected persons was measured using radioimmunodiffusion between 1st and 2nd dose. Fructosamine levels in diabetic persons were assessed for diabetic control and peak expiratory flow rate (PEFR) was self monitored in persons with lung diseases. All groups apart from the elderly filled in a symptom score chart for the first 5 days following vaccination. A 4-fold rise in titre equal to or more than 1:64 to all the 3 antigens occurred in 20 (58.8%) of healthy volunteers compared with 13 (44.8%) diabetics, 5 (35.7%) with lung diseases, 10 (33.3%) elderly and 13 (26.5%) with HIV infection. A significant correlation of serological response to number of CD4 count in persons with HIV infection was noted (H1N1 P=0.0013, H3N2 P=0.025, BYAM P=0.0018). Mean beta2-microglobulin levels did not change significantly post 1st and 2nd vaccination. Mean fructosamine level did not change significantly. There was no significant change in PEFR. The vaccine was well tolerated. Persons with HIV infection and low CD4 count do not serologically respond well to influenza vaccine even with 2 doses compared to the other 4 groups. The other 4 groups had adequate protective serologic responses. The vaccine was well tolerated in all groups.

Neuropsychological performance of HIV-1 infected men with major depression. HNRC Group. HIV Neurobehavioral Research Center

This study sought to determine if human immunodeficiency virus-type 1 (HIV-1) infected depressed men were more likely to be neuropsychologically impaired than their nondepressed counterparts. Subjects were 47 HIV-1 infected men who met DSM-III-R criteria for current major depressive disorder (MDD) and 47 HIV-1 infected nondepressed male controls (M age = 34.2 years) equated on HIV-1 disease severity, demographics, and drug use. The psychiatric interview included the Structured Clinical Inventory for the DSM-III-R, and Hamilton Rating Scale for Depression. The neuropsychological battery included tests covering 8 functional domains based on an expanded Halstead-Reitan Battery. The medical assessment included a history and physical examination, immunologic staging, and evaluation of prescription and recreational drug use. Prevalence of global neuropsychological impairment in the two groups (depressed vs. control) did not differ [53% vs. 38% respectively; chi 2(1, N = 94) = 2.11, p > .05]. While syndromically depressed patients performed less well than nondepressed individuals on memory tests [delayed retention portions of the Story Memory Test: F(1,91) = 5.34, p < .05; and Figure Memory Test: F(1,90) = 4.16, p < .05], the majority of depressed participants (64%) did not have clinically impaired memory. No relationship between neuropsychological impairment and severity of depression was observed. The results suggest that, while HIV-1 infected men with major depression may perform more poorly than nondepressed men on some aspects of memory tasks, they are not more likely to evidence clinically significant neurocognitive impairment.

Standardization of glycated haemoglobin assays throughout the Northern region of England: a pilot study

We describe a pilot study designed to assess the comparability of measurements of glycated haemoglobin among 15 laboratories in the North of England. We also evaluated a means of improving agreement and aligning results by referencing locally measured values to those obtained by the central biochemistry laboratory of the Diabetes Control and Complications Trial research group. Blood samples from 50 diabetic and non-diabetic subjects were analysed for glycated haemoglobin content in the participating and reference laboratories using a variety of routinely available methods. The mean CV for these results was 15.3% (95% confidence interval 14.0% to 16.5%). Using a regression equation relating a subset of seven of these results to their assigned reference values, a glycated haemoglobin index was calculated for all the other samples distributed. The mean inter-laboratory CV improved to 4.6% (95% confidence interval 4.0% to 5.1%), p<0.0001. The percentage bias of results from the reference method also improved from 15.1% (95% confidence interval 9.4 to 20.1) to 4.67% (95% confidence interval 4.05 to 5.25) after alignment, p<0.001. This study demonstrated that substantial method related differences between reported glycated haemoglobin results exist. These can be reduced using a simple calibration strategy in which data are correlated to an established method with associated extensive clinical interpretive value as established by the DCCT.

Obesity and spinal cord injury: an observational study

Obesity as an independent factor influencing the eventual rehabilitation outcome of spinal cord injured individuals has not been examined. This paper is an observational study of two patients with complete tetraplegia secondary to spinal cord injury. Both patients encountered several problems specifically related to their obesity which with the rehabilitation process, and both were far below the expected functional outcome level for a C7 tetraplegic individual at the time of their discharge. Both patients were discharged to facilities providing the highest level of care available in the province.

Membranous lupus nephritis with antineutrophil cytoplasmic antibody-associated segmental necrotizing and crescentic glomerulonephritis

Focal segmental necrotizing and crescentic lupus nephritis accompanied by perinuclear antineutrophil cytoplasmic antibody (P-ANCA) seropositivity is an unusual occurrence. We report the first biopsy-documented cases of membranous lupus nephritis class V with associated "pauci-immune" segmental necrotizing glomerulonephritis and P-ANCA seropositivity. The absence of subendothelial electron-dense deposits favored a manifestation of superimposed ANCA-associated glomerulonephritis rather than class III lupus nephritis. The pathogenetic implications of this association are explored.

Survey of GPs' views of learning disability services

This survey aimed to examine GPs' awareness of the learning disabilities services in Sandwell, West Midlands, and their attitudes towards them. Sixty-two per cent of GPs participated in the study which involved completion of a short questionnaire or interview. The questionnaire was either administered to the GP during a short interview, or completed by a GP who returned the completed questionnaire to the researcher. Only information obtained in response to the questionnaire has been used in collating the data for this survey. The results show that GPs are very confused about what constitutes a learning disability and have only a limited knowledge of the specialist services available to this client group; furthermore, where they were aware of the services available, accessing them was often problematic. Reasons for these findings, along with recommendations, are discussed.

Insulin resistance after hypertension induced by the nitric oxide synthesis inhibitor L-NMMA in rats

To explore the relationship between insulin resistance and hypertension, we examined whether acute induction of hypertension can engender insulin resistance. For this purpose we measured rates of insulin-mediated glucose uptake in awake unstressed rats with the euglycemic hyperinsulinemic (12 microns.kg-1.min-1) clamp technique during infusions of saline alone or after induction of hypertension by bolus administration of NG-monomethyl-L-arginine (L-NMMA, 30 and 15 mg/kg), a competitive inhibitor of nitric oxide synthase. Arterial pressure was approximately 20% greater with L-NMMA bolus than with saline alone. Isotopically determined steady-state rates of glucose uptake were 36 +/- 1 mg.kg-1.min-1 during saline alone and 26 +/- 2 and 19 +/- 1 mg.kg-1.min-1 with low- and high-dose L-NMMA (P < 0.001 vs. saline), respectively. To rule out that insulin resistance induced by L-NMMA was adrenergically mediated, clamp studies were repeated with alpha- and beta-blockade. Rates of glucose uptake remained approximately 20% below those observed with saline alone (P < 0.001). A significant inverse correlation was observed between the height of the blood pressure and the rate of glucose uptake (r = 0.32, P = 0.04). In conclusion, acute induction of hypertension with L-NMMA can cause marked insulin resistance. We postulate that reduced skeletal muscle perfusion and/or sympathetic nervous system activation may contribute to insulin resistance induced by L-NMMA.

Middle management training: investment in the future

Most home care agencies are in desperate need of good middle-level managers. The solution seems to lie in recruiting or promoting people with potential, teaching them the necessary skills, and imparting to them the motivation they need to be successful.

Colonic spreading of a non-chlorofluorocarbon mesalazine rectal foam enema in patients with quiescent ulcerative colitis

BACKGROUND

Rectal foam enemas provide for drug delivery to the distal colon for treatment of left sided ulcerative colitis. However, currently available formulations contain chlorofluorocarbons which are due to be phased out in the near future. The objective of this study was therefore to determine the degree of dispersion of a newly developed non-chlorofluorocarbon rectal foam preparation in ulcerative colitis patients.

METHODS

This was an open label non-controlled study of a single administration of a mesalazine foam enema (two actuations containing 2 g of mesalazine in approximately 120 mL foam) in 10 patients with quiescent ulcerative colitis. Spreading of the 99mTc-labelled foam enema was assessed over a 4-h period by the non-invasive technique of gamma scintigraphy.

RESULTS

All patients retained the enema for the full 4-h imaging period. In nine out of the 10 patients, the enema was observed to spread as far as the descending colon and on average 23% of the dose was present in the descending colon at 4 h post-dose.

CONCLUSIONS

The extent of spreading observed in the study supports the use of the formulation in the treatment of left sided ulcerative colitis.

Availability of thrombolytic therapy in rural Newfoundland and Labrador

OBJECTIVE

To determine the availability of thrombolytic therapy in rural Newfoundland and Labrador.

DESIGN

Self-administered questionnaire mailed to staff at health care facilities. Respondents were sent two reminders by mail, and questionnaires not returned were completed through telephone interviews.

SETTING

Rural health care facilities, including hospitals, 24-hour clinics and satellite clinics.

PARTICIPANTS

All chief medical officers, nursing supervisors and administrators in the 34 government-funded rural health care facilities in Newfoundland and Labrador.

OUTCOME MEASURES

Number of facilities offering thrombolytic therapy to patients with acute myocardial infarction (AMI) in 1992. For each facility: number of patients presenting with AMI during that year, number of these patients who received thrombolytic therapy, number of staff trained in advanced cardiac life support, travel time to the nearest referral centre, population served and number of beds.

RESULTS

Of the 34 rural health care facilities in Newfoundland and Labrador, 91% (31/34) responded to the survey. Thrombolytic therapy was offered in 93% (13/14) of the rural hospitals, 22% (2/9) of the 24-hour clinics and none of the single-physician satellite clinics. In 1992, 390 patients with AMI presented to these health care facilities; 39% of these patients presented to facilities that did not offer thrombolytic therapy.

CONCLUSIONS

Thrombolytic therapy has been successfully introduced in many of the rural and isolated health care facilities in Newfoundland and Labrador. An important factor in this success is continuing medical and nursing education on the effectiveness of thrombolytic therapy and the skills needed to provide it. Cost-effectiveness data are needed to determine whether it is reasonable to offer this therapy in isolated, low-volume clinics. More research on the outcomes in patients receiving thrombolytic therapy in rural facilities is also needed.

Potent and selective inhibition of human nitric oxide synthases. Inhibition by non-amino acid isothioureas

S-Ethylisothiourea was a potent competitive inhibitor of human nitric oxide synthase (NOS), with Ki values of 17, 36, and 29 nM for the inducible (i), endothelial (e), and neuronal (n) isozymes, respectively. Unlike some potent inhibitors of NOS, no time dependence was observed. S-Ethylisothiourea was not a detectable substrate for eNOS. S-Ethylisothiourea was also a potent inhibitor of mouse iNOS (Ki value of 5.2 nM), and its binding perturbed the spectrum of iNOS consistent with its altering the environment of the bound heme. The optimum binding of S-ethyl- and S-isopropylisothiourea relative to 70 other analogs suggested that these alkyl substitutions fit into a small hydrophobic pocket. Most isothioureas were 2-6-fold selective for the human iNOS (Ki for iNOS versus Ki for eNOS), with one being 19-fold selective. The cyclized mimics of S-ethylisothiourea, 2-NH2-thiazoline, and 2-NH2-thiazole, were also competitive inhibitors of human NOS. A third structural class of inhibitors, bisisothioureas, were, in general, the most selective in their inhibition of human iNOS. S,S'-(1,3-Phenylenebis(1,2-ethanediyl))bisisothiourea was 190-fold selective (Ki value of 0.047 microM against iNOS versus 9.0 microM against eNOS). These results demonstrate that potent and selective inhibition of human NOS isozymes is achievable.